University of Texas
Health Science center		 --> School of Medicine --> Department of Medicine
University of Texas Health Science center at San Antonio

Internal Medicine Journal Club

 The University of Texas Medical School at San Antonio

 

 

ARS (opens in new window) - Proxy me

Journal Club - 2006-02-07

Prostate cancer screening

UpToDate:

  • "For an American male, the lifetime risk of developing prostate cancer is 18 percent, but the risk of dying of prostate cancer is only 3 percent "

PubMed citations

1. Prostate Cancer Screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial: findings from the initial screening round of a randomized trial.

Andriole GL, Levin DL, Crawford ED, Gelmann EP, Pinsky PF, Chia D, Kramer BS, Reding D, Church TR, Grubb RL, Izmirlian G, Ragard LR, Clapp JD, Prorok PC, Gohagan JK, PLCO Project Team.
J Natl Cancer Inst 2005;97:433-8. PMID: 15770007
Clinical Trial.
PubMed:
Abstract - Related articles 		  Fulltext options:
CrossRef - DOI - EBSCO - OVID

2. Radical prostatectomy versus watchful waiting in early prostate cancer.

Bill-Axelson A, Holmberg L, Ruutu M, Häggman M, Andersson SO, Bratell S, Spångberg A, Busch C, Nordling S, Garmo H, Palmgren J, Adami HO, Norlén BJ, Johansson JE, Scandinavian Prostate Cancer Group Study No. 4.
N Engl J Med 2005;352:1977-84. PMID: 15888698
Clinical Trial.
PubMed:
Abstract - Related articles 		  Fulltext options:
CrossRef - DOI - EBSCO - OVID

3. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter.

Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA.
N Engl J Med 2004;350:2239-46. PMID: 15163773
Clinical Trial.
PubMed:
Abstract - Related articles 		  Fulltext options:
CrossRef - DOI - EBSCO - OVID

4. Effect of verification bias on screening for prostate cancer by measurement of prostate-specific antigen.

Punglia RS, D'Amico AV, Catalona WJ, Roehl KA, Kuntz KM.
N Engl J Med 2003;349:335-42. PMID: 12878740
Journal Article.
PubMed:
Abstract - Related articles 		  Fulltext options:
CrossRef - DOI - EBSCO - OVID

"Of the 705 men who underwent prostate biopsy (11 percent of the total), 182 received a diagnosis of prostate cancer"

"The ideal threshold value for a recommendation of prostate biopsy depends on the tradeoff between false positive and false negative results. Our analysis therefore did not address which PSA threshold is optimal, but it does show the implications of following current screening recommendations. We found that lowering the threshold for biopsy from 4.1 to 2.6 ng per milliliter in men younger than 60 years would double the cancer-detection rate from 18 percent to 36 percent, whereas the specificity would fall only from 0.98 to 0.94."

"In men under the age of 60 years, the adjustment increased the area under the curve from 0.69 to 0.86 (P<0.001). For men 60 years of age or older, the area under the curve increased from 0.62 without adjustment to 0.72 after adjustment (P=0.008). "

How does all of this compare to breast cancer?

Per USPSTF:

  • "Approximately 1 in 8.2 women will receive a diagnosis of breast cancer during her lifetime, and 1 in 30 will die of the disease"
  • "For a 1-year screening interval, the sensitivity of first mammography ranged from 71% to 96%"
  • "the specificity of a single mammographic examination was 94% to 97%"